Provider First Line Business Practice Location Address:
1830 EAGLE CREST WAY
Provider Second Line Business Practice Location Address:
CLALLAM BAY CORRECTIONS CENTER
Provider Business Practice Location Address City Name:
CLALLUM BAY
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98326-9723
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-963-3237
Provider Business Practice Location Address Fax Number:
360-963-3287
Provider Enumeration Date:
03/29/2007